Key Takeaways

  • If you missed a Medicare enrollment period, you may qualify for a Special Enrollment Period to enroll in Medicare Part B and/or premium Part A without penalty.

  • There are Special Enrollment Periods for certain situations, including losing Medicaid, being released from incarceration, and living in an area impacted by an emergency or disaster.

  • Our fact sheet is a handy reference explaining what's considered an exceptional circumstance when it comes to Medicare enrollment.

What are Medicare Special Enrollment Periods?

Special Enrollment Periods (SEPs) are periods of time outside normal Medicare enrollment periods when you can enroll in health insurance. They are typically triggered by specific circumstances. 

Beginning in 2023, Medicare has established new Special Enrollment Periods for Part B and premium Part A for those who experience an exceptional circumstance. When you enroll in Medicare using one of these SEPs, you will not have a late enrollment penalty. 

If you think you qualify for one of the following SEPs to enroll in Medicare, submit form CMS-10797 to the Social Security Administration. Contact Social Security at 800-772-1213 or find your local office by using the Social Security office locator. 

For help with Medicare enrollment questions, contact your State Health Insurance Assistance Program (SHIP) by visiting www.shiphelp.org or calling 877-839-2675. 

SEP if you were impacted by an emergency or disaster 

This SEP is for people who missed an enrollment opportunity because they or someone who makes health care decisions on their behalf lives in an area where the federal, state, or local government declared an emergency. An example is if you could not enroll in Medicare because your Social Security office was closed to the public.

  • SEP begins: The date the emergency or disaster is declared (as long as it is after Jan. 1, 2023)
  • SEP ends: Six months after the end date of the emergency declaration
  • If the emergency declaration is extended, then the SEP ends six months after the end date of the extension
  • Coverage begins on the first of the month following the month of enrollment

SEP if you got certain types of misinformation from your employer

You can use this SEP if their employer, employer group health plan, or someone acting on behalf of your employer gave you incorrect information that caused you to miss a Medicare enrollment period. You can only use this SEP if you received misinformation on or after Jan. 1, 2023. 

  • SEP begins: The day you notify Social Security of the misinformation (as long as it was on or after Jan. 1, 2023)
  • SEP ends: Six months after you notify Social Security 
  • Coverage begins on the first of the month following the month of enrollment.

When using this SEP, you will have to provide documentation that shows you were misinformed by your employer or their representative. Examples include a letter from the employer that has incorrect information about Medicare enrollment, or a letter from the employer that acknowledges that they gave you misinformation. If you do not have written proof from the employer, you can also submit your own written statement describing the misinformation.

SEP if you were released from incarceration

You can use this SEP if you are released from incarceration on or after Jan. 1, 2023.

  • SEP begins: The day you are released from incarceration 
  • SEP ends: The last day of the 12th month after you are released 
  • There are two options for when your coverage will begin: 
    • The first of the month following the month of enrollment
    • Or, up to six months retroactively (but coverage cannot begin before Jan. 1, 2023, or before you were released from incarceration) 

SEP if your Medicaid coverage is ending

You have an SEP if you lose Medicaid eligibility on or after Jan. 1, 2023.

  • SEP begins: When you receive notice of upcoming termination of your Medicaid eligibility
  • SEP ends: Six months after the termination of eligibility 
  • There are two options for when their coverage will begin: 
    • The first of the month following the month of enrollment 
    • Or, retroactive back to when your Medicaid ended (but no earlier than Jan. 1, 2023)

When using this SEP, you will have to include proof that your Medicaid eligibility ended on or after Jan. 1, 2023. 

If you lost Medicaid and enrolled in Medicare before Jan. 1, 2023 and you now have a late enrollment penalty, contact Social Security to get the penalty removed and to be reimbursed for any penalties you already paid.

SEP if you experience other exceptional circumstances

Social Security can grant an SEP on a case-by-case basis. You can request to enroll through this SEP if you missed other enrollment periods because of situations you could not control. Social Security decides if your situation is exceptional, meaning very unusual or not typical. Forgetting to enroll or not knowing that you were supposed to enroll do not count as exceptional circumstances.

  • SEP timing: Start and end dates of the SEP are determined on a case-by-case basis. 

When using this SEP, you may need to provide proof of the exceptional circumstance. 

Download this Special Enrollment Periods for Exceptional Circumstances illustrated fact sheet to share and keep this information handy: